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2020-03-22

Coronavirus: The Hammer and the Dance

A MUST READ article with links to an interactive epidemic calculator and many simple graphics for understanding best actions to meet challenges of an epidemic.

What the Next 18 Months Can Look Like, if Leaders Buy Us Time

Summary of the article: Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.

Within a week, countries around the world have gone from: “This coronavirus thing is not a big deal” to declaring the state of emergency. Yet many countries are still not doing much. Why?

Every country is asking the same question: How should we respond? The answer is not obvious to them.

Some countries, like France, Spain or Philippines, have since ordered heavy lockdowns. Others, like the US, UK, Switzerland or Netherlands, have dragged their feet, hesitantly venturing into social distancing measures.

Here’s what we’re going to cover today, again with lots of charts, data and models with plenty of sources:

What’s the current situation?

What options do we have?

What’s the one thing that matters now: Time

What does a good coronavirus strategy look like?

How should we think about the economic and social impacts?

When you’re done reading the article, this is what you’ll take away:

Our healthcare system is already collapsing. Countries have two options: either they fight it hard now, or they will suffer a massive epidemic. If they choose the epidemic, hundreds of thousands will die. In some countries, millions. And that might not even eliminate further waves of infections. If we fight hard now, we will curb the deaths. We will relieve our healthcare system. We will prepare better. We will learn. The world has never learned as fast about anything, ever. And we need it, because we know so little about this virus. All of this will achieve something critical: Buy Us Time.

If we choose to fight hard, the fight will be sudden, then gradual. We will be locked in for weeks, not months. Then, we will get more and more freedoms back. It might not be back to normal immediately. But it will be close, and eventually back to normal. And we can do all that while considering the rest of the economy too.

Ok, let’s do this.

1. What’s the situation?

As predicted, the number of cases has exploded in dozens of countries. Here, I was forced to show only countries with over 1,000 cases. A few things to note:

Spain, Germany, France and the US all have more cases than Italy when it ordered the lockdown

An additional 16 countries have more cases today than Hubei when it went under lockdown: Japan, Malaysia, Canada, Portugal, Australia, Czechia, Brazil and Qatar have more than Hubei but below 1,000 cases. Switzerland, Sweden, Norway, Austria, Belgium, Netherlands and Denmark all have above 1,000 cases.

Do you notice something weird about this list of countries? Outside of China and Iran, which have suffered massive, undeniable outbreaks, and Brazil and Malaysia, every single country in this list is among the wealthiest in the world.

Do you think this virus targets rich countries? Or is it more likely that rich countries are better able to identify the virus?

The most likely interpretations are that the coronavirus either took longer to reach these countries because they’re less connected, or it’s already there but these countries haven’t been able to invest enough on testing to know.

Either way, if this is true, it means that most countries won’t escape the coronavirus. It’s a matter of time before they see outbreaks and need to take measures.

What measures can different countries take?

2. What Are Our Options?

Since the article last week, the conversation has changed and many countries have taken measures. Here are some of the most illustrative examples:

Measures in Spain and France

In one extreme, we have Spain and France. This is the timeline of measures for Spain:

On Thursday, 3/12, the President dismissed suggestions that the Spanish authorities had been underestimating the health threat. On Friday, they declared the State of Emergency. On Saturday, measures were taken:

Weddings can’t have guests. Funerals can’t have more than a handful of people.

Mass transit remains open

On Monday, land borders were shut.

Some people see this as a great list of measures. Others put their hands up in the air and cry of despair. This difference is what this article will try to reconcile.

France’s timeline of measures is similar, except they took more time to apply them, and they are more aggressive now. For example, rent, taxes and utilities are suspended for small businesses.

Measures in the US and UK

The US and UK, like countries such as Switzerland or Netherlands, have dragged their feet in implementing measures. Here’s the timeline for the US:

Wednesday 3/11: travel ban.

Friday: National Emergency declared. No social distancing measures

Monday: the government urges the public to avoid restaurants or bars and attend events with more than 10 people. No social distancing measure is actually enforceable. It’s just a suggestion.

Lots of states and cities are taking the initiative and mandating much stricter measures.

The UK has seen a similar set of measures: lots of recommendations, but very few mandates.

These two groups of countries illustrate the two extreme approaches to fight the coronavirus: mitigation and suppression. Let’s understand what they mean.

Option 1: Do Nothing

Before we do that, let’s see what doing nothing would entail for a country like the US:

If we do nothing: Everybody gets infected, the healthcare system gets overwhelmed, the mortality explodes, and ~10 million people die (blue bars). For the back-of-the-envelope numbers: if ~75% of Americans get infected and 4% die, that’s 10 million deaths, or around 25 times the number of US deaths in World War II.

You might wonder: “That sounds like a lot. I’ve heard much less than that!”

So what’s the catch? With all these numbers, it’s easy to get confused. But there’s only two numbers that matter: What share of people will catch the virus and fall sick, and what share of them will die. If only 25% are sick (because the others have the virus but don’t have symptoms so aren’t counted as cases), and the fatality rate is 0.6% instead of 4%, you end up with 500k deaths in the US. Still massive. But 20 times less than above.

The fatality rate is crucial, so let’s understand it better. What really causes the coronavirus deaths?

Conclusion: Buy Us Time

The coronavirus is still spreading nearly everywhere. 152 countries have cases. We are against the clock. But we don’t need to be: there’s a clear way we can be thinking about this.

Some countries, especially those that haven’t been hit heavily yet by the coronavirus, might be wondering: Is this going to happen to me? The answer is: It probably already has. You just haven’t noticed. When it really hits, your healthcare system will be in even worse shape than in wealthy countries where the healthcare systems are strong. Better safe than sorry, you should consider taking action now.

For the countries where the coronavirus is already here, the options are clear.

On one side, countries can go the mitigation route: create a massive epidemic, overwhelm the healthcare system, drive the death of millions of people, and release new mutations of this virus in the wild.

On the other, countries can fight. They can lock down for a few weeks to buy us time, create an educated action plan, and control this virus until we have a vaccine.

Governments around the world today, including some such as the US, the UK, Switzerland or Netherlands have so far chosen the mitigation path.

That means they’re giving up without a fight. They see other countries having successfully fought this, but they say: “We can’t do that!”

What if Churchill had said the same thing? “Nazis are already everywhere in Europe. We can’t fight them. Let’s just give up.” This is what many governments around the world are doing today. They’re not giving you a chance to fight this. You have to demand it.

Share the Word

Unfortunately, millions of lives are still at stake. Share this article—or any similar one—if you think it can change people’s opinion. Leaders need to understand this to avert a catastrophe. The moment to act is now.